This is not an attractive film. I don’t say that because it is poorly shot, because some of the fantasy sequences are absolutely gorgeous in a way. The images are gloriously vibrant, and they might even be enjoyable to look at if they weren’t filled with gruesome and disgusting images. The main star is made to look purposefully unattractive much of the film. Even when she does look glamorous in her fantasies, her actions are always disturbing enough to counter this. This is a film filled with unattractive images and ideas, making it far from easy to sit through without squirming uncomfortably.

AnnaLynne McCord gives a bold performance as Pauline, a role which calls for her to be as unattractive as possible for much of the film. Only within fantasy sequences does she look glamorous, and this is countered with gruesome and graphic images of blood and carnage. Pauline is an unpopular high school student who exists within her own demented world of bizarre ideas and a strange secret fetish. Though she is an outcast, Pauline pays little attention to what anybody else says or thinks of her. When she gets an idea in her head, it doesn’t matter what obstacles are in her way.

In one particularly disturbing sequence, Pauline decides that she is ready to lose her virginity. Though she is unpopular, a blunt proposal to a popular kid proves all that is needed. What is more disturbing is the manner in which Pauline desires to lose her virginity, and even more upsetting are the implications of her determination. Throughout the film Pauline’s ultimate psychosexual fantasies are of graphic surgery, and it becomes clear that she may even be disturbed enough to carry out a fantasy of her own in real life.

The Blu-ray release has an audio commentary track with director Richard Bates, Jr. and McCord. This is the only special feature, though the fantasies are filmed in a way which is enhanced by the high definition presentation of the Blu-ray. The film is disturbing regardless, but it is the contradiction of beauty and destruction that makes Excision far more sophisticated than and layered than your average horror film.